Refining StrokeTreatment

Better patient outcome linked to
Get With The Guidelines-Stroke

troke patients at hospitals participating in anationwide quality-improvement program weremore likely to be discharged home and lesslikely to die after discharge than patients innon-participating hospitals, according to researchin the American Heart Association’s journal Stroke.

The program, Get With The Guidelines®-Stroke,
established by the American Heart Association/American
Stroke Association in 2003, helps hospitals provide stroke
patients with the latest, most effective treatment for stroke.
More than 1,600 hospitals have registered to receive patient-management toolkits, access to workshops, decision support
and many other resources.

“We know that in the past the Get With The Guidelines-Stroke program was associated with improved processesof care, such as appropriate medications and otherM.D., M.P.H., lead author of the study and an assistantprofessor in neurology at Rush University Medical Centerin Chicago, IL. “Now we know that thisimproved care translates into improvedclinical outcomes.”In this study, stroke patients whoreceived treatment at hospitals participatingin the Get With The Guidelines®-Strokeprogram were 10 percent more likelythan those in non-participating hospitalsto be discharged home, rather than toa rehabilitation center or other facility.Furthermore, 30 days and one year afterdischarge, patients from participatinghospitals were 7 percent to 8 percent lesslikely to have died. These findings meanthat in this study alone, participatinghospitals discharged about 1,000 morestroke patients home than non-participatinghospitals, and about 2,900 fewer patientsdied within one year.

“By improving the infrastructure for stroke care, the
program has been effective, not only in improving measures
of process and care, but also clinical outcomes, which is
what patients should care about most,” Song said.

The study consisted of 173,985 Medicare patients with
stroke caused by a blocked blood vessel. Roughly half of
participants received treatment at hospitals participating
in Get With The Guidelines®-Stroke, while the other half
was treated at non-participating hospitals. Participants’
average age was 79 years, three-fifths were women, and
most were white.

Investigators analyzed data from the Centers for Medicare
& Medicaid Service for 366 hospitals participating in Get
With The Guidelines®-Stroke and 366 non-participating
hospitals. The study ran from April 1, 2003 to December 1,
2008, data collection began 18 months before participating
hospitals’ joined the program, and follow-up was up to 18
months after program implementation.

A study limitation is that unforeseen factors could
have affected the results, although investigators did match
patients and hospitals in terms of their characteristics. In
addition, the study did not measure disability after hospital
discharge and could not control for whether or not patients
followed treatment recommendations after leaving the
hospital. This study was also done only in the Medicare
population, so only in people aged 65 or older.